When clinicians diagnose & treat based on outdated or inadequate knowledge, then outcomes are at best uncertain. The internet itself is a poor information source; & colleagues may be no more up-to-date that you.

Good sources are the world-wide Cochrane Collaboration and the specific evidence-based practice journals that are beginning to grow–these take best information from the research report all the way through clinical recommendations. For research reports per se,PubMed is a comprehensive, U.S. tax-supported database; & there when you find information that fits using your key search terms, you can also look for related articles & get full-text through interlibrary loan or online. Another strategy is take the article that fits your clinical issue to your librarian, and ask for help in finding more research on the identical clinical issue.

While no one can read everything in the literature, everyone can read something. You can do a focused review on any particular problem.

Critical thinking: Is there a clinical issue that you think could use a better solution? Plug related words into PubMed & see what you can learn.

Google–not to mention yahoo, bing & other web search engines–are mere popularity contests of literature. Google Scholar is a step up, but it is still a search engine. It can miss important articles entirely.

If you want to be sure that you are getting the BEST, you gotta look in the right place if you want to find the right articles on the right topic at the right time!

Reputable publishers give away very few articles for free, so when you want the best literature out there you need a Database that will systematically help you to find quality articles that fit your topic.

PubMed.gov is a tax funded database that is highly comprehensive. CINAHL is strong on nursing literature. If you are enrolled in a university, you have access to lots of full-text articles at no added cost. Check with your librarian if your database search is not turning up what you need–with a few hints, you could get the best.

Outcome= Reduce time of postop ileus with sooner return to nutritious eating

We would:

Using PICO, identify key concepts (words), such as “postoperative ileus” “gum chewing” and “NPO.” Note that you can pick single words or combinations of words.

Search for this set of words in the very comprehensive databases of PubMed and also in CINAHL. CINAHL is more nursing specific, and PubMed is one of the most comprehensive out there. Search from MOST RECENT to earlier. Go for only most recent 5 years unless 5 years doesn’t give you enough articles.

Keep notes of exactly which words and phrases you used to search each database

Today’s top tip: Want to find the strongest research evidence for your project? Go to http://www.ncbi.nlm.nih.gov/pubmed & add the strongest type of research designs as one of your search terms. For example, add the terms meta-analysis or systematic review to your other search terms. **********************************************

First, remember that in a descriptive study, the researcher merely watches or listens to see what is happening. Descriptive studies do not test interventions.

Second, a systematic review (not to be too silly) is a review that is done systematically in order to include all literature on a particular topic . The authors will tell us where they searched for studies, what search terms they used, and what years they searched. That way we can feel sure that all relevant articles are included.

Therefore, in a systematic review of descriptive studies the authors

Collect non-experimental studies related to the problem they are trying to solve,

Critically review them, &

Write up that analysis for you and me.

You won’t see a lot of numbers or statistics in these reviews of non-experimental studies.

Systematic review of descriptive studies are weaker than other levels of evidence in part because they are critical reviews of non-experimental studies in which the researchers only observed subjects. Those non-experimental studies that they are reviewing may be quantitative with results reported in numbers or qualitative with results reported in words.

Here’s an example with results reported in words (qualitative): Yin, Tse, & Wong (2015) systematically reviewed studies for what factors affect RNs giving PRN opioids in the postop period. They searched publications 2000-2012 and ended up with 39 relevant studies. Within those 39 articles were descriptive studies that identified 4 basic influences on opioid PRN administration by RNs to postop patients: “(i) nurses’ knowledge and attitudes about pain management; (ii) the situation of nurses’ work practices in administrating range orders for opioid analgesics; (iii) factors that influenced nurses’ work practices; and (iv) perceived barriers to effective pain management from the nurse’s perspective.” [note: In this study a few of the 39 studies were experimental in which something was done to subjects and then outcomes measured, and Yin et al., commented separately on what those showed.]

You can avoid re-inventing the wheel by checking in with top notch experts who have already examined the practice problem that you face.

In other words, it’s time to head to the library. After all that’s what the library is: the experiences and research written down by experts, who have spent a lot of time thinking about the same problem that you are facing. Really it’s pretty amazing that we have access to health professionals all over the world who are eager to help you avoid re-inventing the wheel.

The best experts in the field are talking directly to you through their publications!

Of course it’s important to ask your colleagues in your own and other institutions about their ideas on the problem, but that’s not enough. You will be limited by what they happen to know; or worse you will be limited by what they don’t happen to know! Nurses on your floor can provide practical, site-specific insights, but it’s easy to see why you would want to add newest information from the top experts. That is BEST evidence.

Use single words or put phrases in parenthesis in your list of words (e.g., “postoperative ileus”). A librarian can help with key words, too.

Google the site PubMed (PubMed is a complete database of healthcare publications)

In the search box at the top of the PubMed page, type in your key words

You will get a list of articles on your topic (and some related articles on the right side)

Click on the box beside the ones that you want & email that list to your facility librarian with a request to pull the complete articles for you! (Of course if you are a student with some direct access to full-text articles in a school library, then it may be quicker to get them on your own. It’s up to you, but part of your “village that it takes” might be the librarian.) [See “Take five!” if you want more on to why PubMed beats Google Scholar.]

If you want to solve a priority clinical problem using the best research evidence out there, you & your team have at least a couple of options:

1) You can DIY (do it yourself), which means finding, critiquing, synthesizing, and translating the research into clinical practice recommendations: OR

2) You can take advantage of experts’ work by finding evidence-based clinical practice guidelines that you can simply adopt or adapt to your setting.

Either option is good, but in this post I want to focus on option #2: Evidence-based practice guidelines.

What are practice guidelines? Clinical practice guidelines are “systematically developed statements” that help RNs, other providers, and patients to decide on the best course of care. When the guideline authors use research to write them, then we call them evidence-based practice guidelines (http://www.agreetrust.org/resource-centre/practice-guidelines/).

What’s the advantage? In evidence-based practice guidelines, experts have already done the hard work of finding, critiquing, synthesizing, and translating the research into practice recommendations for you. You need only to adopt or adapt them to fit your setting, and establish a regular review time to make sure they are supporting excellent care and still in date.

Where can you find EBP practice guidelines to adopt or adapt? A few places are:

Consider “bookmarking” these sites or adding them to your “favorites” in your internet browser.

You may even find multiple guidelines on your subject. Then you and your team get to choose the one that BEST fits your setting & solves the clinical problem! How cool is that? (Note: The gold standard for critiquing guideline quality is the AGREE II tool, but ….more on that another day.)

Critical thinking exercise

Go to National Guidelines Clearinghouse.

Search for “family presence during resuscitation”

Look at the ENA clinical practice recommendations on that page and see how strong the evidence is to support each one. (You can also take a look at the process of guideline development & the research used to support it.)

Then decide how might you adopt or adapt one of those recommendations in your own setting?

Have an informal conversation with a colleague about your thoughts on this.

If you can use one or more of the recommendations, you have now brought more research evidence into your practice. Congratulations!!

One of your search terms can be nurs* if you want a better chance of finding only nursing articles. You’ll know what that little asterisk means after you “TAKE 5!” with the first video link.

Some PubMed articles are free for you to print or save. Many are not. That means you will need to take the list of articles that you found in your search to your hospital librarian for help. OR if you have access to library databases through a school you can find full text of most articles there or order them through interlibrary loan.

If you don’t have access to library databases yourself, here’s a good way to work with a hospital librarian.

Use the 4 search strategies to find relevant articles on PubMed.

Give that list of articles to your librarian who is likely to have a budget and time to pull the full articles for you.

If you find only one article that fits the problem you are trying to solve, you can take that article to the librarian and ask the person to find you more like that one.